Tyshara Hines
High Point
Summary
Knowledgeable certified nurse aide with strong foundation in patient care and support. Demonstrated ability to assist with daily living activities and maintain safe and clean environment for patients. Showcased excellent communication and teamwork skills in clinical settings. Strong foundation in patient care, safety protocols, and clinical skills. Valued for effective team collaboration and adaptability to changing needs. Known for reliability and achieving results in fast-paced environments. Skilled in communication, empathy, and problem-solving.
Overview
11
11
years of professional experience
Work History
Prior Authorization Specialist
CoreLife
Winston-Salem, NC
09.2023 - Current
- Evaluated and processed prior authorization requests to ensure compliance with insurance guidelines.
- Collaborated with healthcare providers to gather necessary documentation for approval processes.
- Facilitated communication between patients, providers, and insurers to resolve authorization issues.
- Maintained accurate records of authorization requests and outcomes in electronic health record systems.
- Mentored junior staff on best practices for efficient request processing and documentation standards.
- Implemented workflow improvements that reduced processing time for prior authorizations by streamlining procedures.
- Analyzed trends in authorization denials to recommend policy changes and enhance approval rates.
- Collaborated with physicians to obtain necessary clinical information for prior authorization submissions.
- Verified eligibility and compliance with authorization requirements for service providers.
- Responded to inquiries from healthcare providers regarding prior authorization requests.
- Evaluated clinical criteria for approval or denial of services requiring pre-authorization.
- Reduced turnaround time for prior authorization requests by utilizing electronic submission methods.
- Monitored pending cases closely, proactively following up on outstanding documentation needed for successful approval outcomes.
- Researched denied claims and contacted insurance companies to resolve these issues.
Pharmacy Technician, Certified Rep, Prior authorizations
CVS Caremark
01.2021 - 09.2023
- Secured CPHT pharmacy technician license to support pharmacy operations and enhance patient care.
- Triage incoming calls from members, providers, and/or pharmacies
- Maintain complete, timely, and accurate documentation of all approvals and denials
- Collaborated with team members to efficiently process prior authorizations.
- Efficiently working in various systems, while remaining flexible and organized
- Cross trained in various departments such as commercial prior authorizations and novologix.
- Troubleshooting claim rejections and applying overrides into the system.
- Remote
Pharmacy Technician (Long term care)
Realo extended care
New Bern, NC
01.2020 - 01.2021
- Preparing and packaging new prescription and refill requests for patients
- Dispensing medication to patients per the prescription, or provider’s orders
- Packaging and labeling prescription medications
- Managed processing of insurance claims to ensure timely resolution and customer satisfaction.
- Tracking inventory
- Filling automated dispensing machine(s)
- Repackaging of bulk medications
- Working alongside Pharmacists to ensure the health and safety of their patients
Child and Youth Program Assistant
Age Services
Fort Hood, TX
01.2017 - 01.2018
- Provided appropriate specialized developmental care and instruction for program participants
- Communicated effectively with program assistants so that work is accomplished as scheduled and in compliance with applicable procedures
- Monitored participants for illness, abuse, or neglect, and reported findings. Ensured compliance to safety, fire, fitness, health, and nutrition procedures
- Maintained indoor and outdoor activities areas, materials, and schedule
Sales Merchandiser
Burlington Stores
Killeen, TX
01.2016 - 01.2017
- Maintained established merchandising standards, including window, sales floor, and promotional displays
- Handled and resolved customer inquiries, complaints, and sales questions; maintained professionalism and good judgment while dealing with difficult customers
- Stocked and replenished merchandise according to store merchandising layouts; maintained accountability of inventory
- Promoted and advised customers on products and merchandise; recommended and helped customers locate merchandise based on their needs and preferences
Teacher Aide/Assistant
Trac Little Apples Childcare & Preschool
Winterville, NC
01.2016 - 01.2016
- Developed and resourced visual aids, equipment, and displays
- Provided diverse assistance to teachers, including classroom management and document coordination
- Worked with individual students to provide personalized education, behavioral and emotional support; documented behaviors, interventions, and results
- Improved student participation in the classroom through integration of creative role-playing exercises
Cashier
Piggly Wiggly
Greenville, NC
01.2015 - 01.2016
- Assisted customers with food selection, inquiries, and order customization requests
- Operated a cash register and processed cash, check, and credit card transactions with 98% accuracy
- Stocked and replenished merchandise according to the store merchandising layouts; designed displays to make the store experience interactive, engaging, and reassuring
- Communicated all store initiatives and promotions to customers to generate return business
Education
Associate of Applied Science - Medical Assisting
Liberty University
Lynchburg, VA05-2024
No Degree - Certified Nurse Aide
Arise Health Training Institute
High Point, NC02-2026
Skills
- Leadership
- Training and Development
- Microsoft Office Suite
- Quality Assurance
- Policy Implementation
- Inventory Control
- Records Management
- Process Improvement
- Organizational Communication
- Medical terminology
- Basic life support
- Patient safety
- Transfer techniques
- Range of motion exercises
- Activities of daily living ADL support
- Vital signs
- Attention to detail
Section name
Authorized to work in the US for any employer
Timeline
Prior Authorization Specialist
CoreLife
09.2023 - Current
Pharmacy Technician, Certified Rep, Prior authorizations
CVS Caremark
01.2021 - 09.2023
Pharmacy Technician (Long term care)
Realo extended care
01.2020 - 01.2021
Child and Youth Program Assistant
Age Services
01.2017 - 01.2018
Sales Merchandiser
Burlington Stores
01.2016 - 01.2017
Teacher Aide/Assistant
Trac Little Apples Childcare & Preschool
01.2016 - 01.2016
Cashier
Piggly Wiggly
01.2015 - 01.2016
Associate of Applied Science - Medical Assisting
Liberty University
No Degree - Certified Nurse Aide
Arise Health Training Institute